Real world benefits of diabetes management app usage and SMBG on glycemic control (Preprint)

2021 ◽  
Author(s):  
Chang Ya Ting ◽  
Yu-Zhen Tu ◽  
Hung-Yi Chiou ◽  
Ken Lai
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Real World ◽  
Mixed Model ◽  
Diabetes Management ◽  
Mobile App ◽  
Diabetes Duration ◽  
Percentage Change ◽  
User Group ◽  
Management Platform

BACKGROUND Among the self-care measures, self-monitoring of blood glucose (SMBG) is a critical component for checking blood glucose levels. However, for non-insulin-treated DMT2 patients, the value of SMBG was inconsistent among studies. In addition, there is growing evidence suggesting that digital technologies are being adopted as an additional method for healthcare systems to increase patient contact. However, evidence from real-world clinical practice is still limited. OBJECTIVE To assess non-insulin-treated DMT2 patients that were receiving care from the same clinic and analyze whether usage of a diabetes management app and SMBG behavior affect glycemic control in real-world clinical settings. METHODS We collaborated with a large clinic in Taiwan focused on diabetes care that has been using the Health2Sync mobile app and web-based Patient Management Platform to collect the data. The patients were divided into two groups (app-engaged-user, only-data-uploader) according to different activities in the app, and blood glucose was recorded every month from 1 to 6 months after registration in the app. A sample of 420 patients was included in the analysis, and a linear mixed model was built to investigate what factors affect patients' blood glucose percentage change. RESULTS With the mixed model coefficient estimates, we found that the percentage change was significantly negative when the only-data-uploader group was set as the baseline (t = -4.289, P < .001 for the patients of app-engaged-user group).Furthermore, we found that for patients with shorter diabetes duration the blood glucose decreased more ( t = 4.219, P < .001 for the number of diabetes duration). Finally, we also found that the count of blood glucose measured enlarged the decrease along the interaction months (t = -6.911, P < .001 for Nth month * count of blood glucose in Nth month). CONCLUSIONS Our analysis showed that the blood glucose percentage change of the patient who was in the app-engaged-user group dropped more than that of the patient who was in the only-data-uploader group, shorter diabetes duration is associated with steeper decrease in the patient's blood glucose percentage change, and the more frequently patients test SMBG each month, the higher the decrease in the patient's blood glucose percentage. Further studies can be performed to consider the differences in daily behaviors such as exercise, diet across the patients, and these factors could have vital impacts on glycemic control.

scholarly journals The Effects of Continuous Usage of Diabetes Management App on Glycemic Control in Real-world Clinical Practice: Retrospective Analysis (Preprint)

2020 ◽  
Author(s):  
Yu-Zhen Tu ◽  
Ya-Ting Chang ◽  
Hung-Yi Chiou ◽  
Ken Lai
Keyword(s):  
Clinical Practice ◽  
Glycemic Control ◽  
Real World ◽  
Mixed Model ◽  
Diabetes Management ◽  
Mobile App ◽  
Bonferroni Correction ◽  
Retention Group ◽  
Level Of Use ◽  
One Year

BACKGROUND The efficacy of digital technology in improving diabetes management has typically been demonstrated through studies based on randomized controlled trials (RCTs), showing steeper decrease of hemoglobin A1c (HbA1c) values for patients who adopted a digital solution. However, evidence from real-world clinical practice is still limited. OBJECTIVE To evaluate the effectiveness of digital interventions by tracking HbA1c improvement over one year in real-world clinical settings. METHODS The Health2Sync mobile app was used by patients to track self-measured outcomes and communicate with health care professionals (HCPs). The web-based Patient Management Platform was used by HCPs to monitor patient data, view test results from clinical labs, and communicate with patients. Patients that have been onboarded for at least 13 months and had consecutive HbA1c results for five quarters were included in the analysis. They were then stratified into three groups (high, mid, and low retention) according to their level of use of the mobile app in the first six months after onboarding. A mixed model was built to compare the slopes of HbA1c percentage decreases between the groups. In addition, these patients’ stickiness on the app from the seventh to the twelfth month was verified with multiple comparisons. RESULTS A sample of 2036 users was included in the analysis. With the mixed model coefficient estimates, we found that app users had significant HbA1c percentage decreases as the passed quarter count increased (t = -9.869, P < .001), and that effectiveness was enlarged in high and mid retention groups as the interaction effects were significantly negative compared with the low retention group (t = -6.620, P < .001 for passed quarter count * mid retention; t = -5.173, P < .001 for passed quarter count * high retention). The low retention group also had the highest average HbA1c value in the end of the 13 months [mean (SD): 7.01 (1.02) %, 6.99 (1.00) %, and 7.17 (1.14) % for high, mid, and low retention groups, respectively, P = .07, .02, and 1.00 for high-low, mid-low, and high-mid difference comparison after Bonferroni correction]. The level of use of the app remained consistent in the seventh to the twelfth month after onboarding [mean (SD): 5.23 (1.37) months, 2.43 (1.68) months, and 0.41 (0.97) months for high, mid, and low retention groups, respectively, P < .001 for all comparison pairs after Bonferroni correction]. CONCLUSIONS Our analysis showed that continuous usage of the diabetes management app is associated with better glycemic control in real-world clinical practice. Further studies can be performed to reveal the efficacy for specific diabetes types and to observe the effects beyond one year.

scholarly journals Digital Diabetes Management Application Improves Glycemic Outcomes in People With Type 1 and Type 2 Diabetes

2017 ◽  
Vol 12 (3) ◽  
pp. 701-708 ◽  
Author(s):  
Reid Offringa ◽  
Tong Sheng ◽  
Linda Parks ◽  
Mark Clements ◽  
David Kerr ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Real World ◽  
Diabetes Management ◽  
Mobile Platform ◽  
Blood Glucose Monitoring ◽  
Mixed Effect ◽  
Management Platform

Background: Diabetes is a chronic condition that requires constant self-management. As a consequence, several software platforms have been developed to facilitate the tracking of diabetes data to improve diabetes management. Our aim was to determine the real-world glycemic benefits of a mobile diabetes management platform used by individuals with type 1 and type 2 diabetes. Methods: Mobile platform-using (n = 899) and control (n = 900) participants meeting specific minimum data criteria were randomly selected from a database of diabetes users. All results were modeled using different mixed effect generalized linear models, assigning random intercepts for each user, and adjusting the distribution assumption for each outcome. Results: Users of the mobile platform increased their frequency of blood glucose monitoring (+8.8 tests per month, 95% CI [3.4, 14.1], P < .001) and had fewer hyperglycemic events and lower average glucose levels compared to the control group. In addition, a mobile user could expect a 3.5% drop in average BG (−6.4 mg/dL, 95% CI [−2.0, −10.7], P < .001) and a 10.7% decrease in hyperglycemia ( P < .001) after 2 months. Conclusion: Users of the mobile platform tested their BG more often and demonstrated greater improvement in blood glucose compared to users who did not use the mobile platform. This supports previous studies indicating that digital technologies can enhance diabetes care in a real-world setting.

Evaluation of a Continuous Blood Glucose Monitor: A Novel and Non-Invasive Wearable Using Bioimpedance Technology

2021 ◽  
pp. 193229682110541
Author(s):  
Farid Sanai ◽  
Arshman S. Sahid ◽  
Jacqueline Huvanandana ◽  
Sandra Spoa ◽  
Lachlan H. Boyle ◽  
...  
Keyword(s):  
Mathematical Model ◽  
Blood Glucose ◽  
Real World ◽  
Diabetes Management ◽  
Glucose Monitoring ◽  
Relative Difference ◽  
Self Monitoring ◽  
Non Invasive ◽  
Adult Participants ◽  
Blood Glucose Monitor

Background: Frequent blood glucose level (BGL) monitoring is essential for effective diabetes management. Poor compliance is common due to the painful finger pricking or subcutaneous lancet implantation required from existing technologies. There are currently no commercially available non-invasive devices that can effectively measure BGL. In this real-world study, a prototype non-invasive continuous glucose monitoring system (NI-CGM) developed as a wearable ring was used to collect bioimpedance data. The aim was to develop a mathematical model that could use these bioimpedance data to estimate BGL in real time. Methods: The prototype NI-CGM was worn by 14 adult participants with type 2 diabetes for 14 days in an observational clinical study. Bioimpedance data were collected alongside paired BGL measurements taken with a Food and Drug Administration (FDA)-approved self-monitoring blood glucose (SMBG) meter and an FDA-approved CGM. The SMBG meter data were used to improve CGM accuracy, and CGM data to develop the mathematical model. Results: A gradient boosted model was developed using a randomized 80-20 training-test split of data. The estimated BGL from the model had a Mean Absolute Relative Difference (MARD) of 17.9%, with the Parkes error grid (PEG) analysis showing 99% of values in clinically acceptable zones A and B. Conclusions: This study demonstrated the reliability of the prototype NI-CGM at collecting bioimpedance data in a real-world scenario. These data were used to train a model that could successfully estimate BGL with a promising MARD and clinically relevant PEG result. These results will enable continued development of the prototype NI-CGM as a wearable ring.

scholarly journals Results of a Study Comparing Glycated Albumin to Other Glycemic Indices

2019 ◽  
Vol 105 (3) ◽  
pp. 677-687 ◽  
Author(s):  
Cyrus V Desouza ◽  
Richard G Holcomb ◽  
Julio Rosenstock ◽  
Juan P Frias ◽  
Stanley H Hsia ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Diabetes Management ◽  
Pearson Correlation ◽  
Glycated Albumin ◽  
Individual Subject ◽  
Glycemic Indices ◽  
Glucose Profiles ◽  
The Individual ◽  
Pearson Correlations

Abstract Context Intermediate-term glycemic control metrics fulfill a need for measures beyond hemoglobin A1C. Objective Compare glycated albumin (GA), a 14-day blood glucose measure, with other glycemic indices. Design 24-week prospective study of assay performance. Setting 8 US clinics. Participants Subjects with type 1 (n = 73) and type 2 diabetes (n = 77) undergoing changes to improve glycemic control (n = 98) or with stable diabetes therapy (n = 52). Interventions GA, fructosamine, and A1C measured at prespecified intervals. Mean blood glucose (MBG) calculated using weekly self-monitored blood glucose profiles. Main Outcome Measures Primary: Pearson correlation between GA and fructosamine. Secondary: magnitude (Spearman correlation) and direction (Kendall correlation) of change of glycemic indices in the first 3 months after a change in diabetes management. Results GA was more concordant (60.8%) with changes in MBG than fructosamine (55.5%) or A1C (45.5%). Across all subjects and visits, the GA Pearson correlation with fructosamine was 0.920. Pearson correlations with A1C were 0.655 for GA and 0.515 for fructosamine (P &lt; .001) and with MBG were 0.590 and 0.454, respectively (P &lt; .001). At the individual subject level, Pearson correlations with both A1C and MBG were higher for GA than for fructosamine in 56% of subjects; only 4% of subjects had higher fructosamine correlations with A1C and MBG. GA had a higher Pearson correlation with A1C and MBG in 82% and 70% of subjects, respectively. Conclusions Compared with fructosamine, GA correlates significantly better with both short-term MBG and long-term A1C and may be more useful than fructosamine in clinical situations requiring monitoring of intermediate-term glycemic control (NCT02489773).

scholarly journals SUN-692 Comprehensive and Structured Care Program for Patients with Type 2 Diabetes Mellitus: A Preliminary Report from Raipur, Chhattisgarh State of India

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Kalpana Dash ◽  
Surekha Tippisetty ◽  
Samba Siva Rao ◽  
Vamsi Krishna Kolukula
Keyword(s):  
Blood Glucose ◽  
Diabetes Management ◽  
Care Program ◽  
Mobile App ◽  
Phone Call ◽  
Hypoglycemic Agents ◽  
Oral Hypoglycemic Agents ◽  
Self Monitoring ◽  
Structured Care ◽  
Glycemic Outcomes

Abstract Aim: To assess the glycemic outcomes of T2DM patients enrolled in comprehensive structured care program at the outpatient clinic of Apollo Sugar at Raipur, India. Methods: This is a preliminary, prospective, single-center, observational study on T2DM patients from Jan 2018 to December 2018. Uncontrolled diabetes or patients with comorbid conditions with the duration of disease for more than one year and age ≥18 years and who gave consent to enroll in the program were included in the study. The structured care program is a 6 months program where patients were continuously engaged by counseling them on diabetes management- diet and exercise, self-monitoring of blood glucose, health interactions with the remote health coach through a mobile app. Baseline demographics and clinical data were collected at the time of enrollment and were followed up for 6 months. HbA1c reduction is the target measurement of this program. Descriptive statistics were used to analyze and report the data. A paired t-test is used to check the significant reduction in HbA1c from baseline to follow up Results: Total 102 patients were included in this study. Mean (SD) age was 50.7 (10.5) years, males were 78 (76%) and females were 24 (24%). The mean (SD) duration of diabetes and BMI were 7.9 (7.0) years and 27.5 (4.5) kg/m2 respectively. At the time of enrollment, patients were at mean HbA1c of 9.0(2.1)%, fasting (F) and post-prandial (PP) blood (BG) glucose was 194(68) mg/dL and 247(94) mg/dL respectively. Among these patients 38% had neuropathy and 15% had retinopathy as their complications. These patients were regularly followed up over the phone call to counsel on diabetes management with a healthy diet, exercise, self-monitoring of blood glucose, and medication compliance. After 6 months followup the HbA1c, FBG, and PPBG were 7.6 (1.5) %, 139 (50) mg/dL, and 196 (75) mg/dL, respectively with a significant mean reduction of 1.4%, 56 mg/dL, and 51 mg/dL (p &lt;0.001). Further analysis of glycemic outcomes between these patients on oral hypoglycemic agents (OHAs) and OHAs+insulin, the reduction in HbA1c (1.5%) was not significant. Conclusion: Our study demonstrates that a structured care program might bring a clinically significant glycemic control through tight adherence to SMBG, diet, exercise, and medication. To establish these results a study in large sample is in progress.

scholarly journals Use of a Meter With Color-Range Indicators and a Mobile Diabetes Management App Improved Glycemic Control and Patient Satisfaction in an Underserved Hispanic Population: “Tu Salud”—a Randomized Controlled Partial Cross-Over Clinical Study

2021 ◽  
Author(s):  
Maria Aparicio ◽  
Laurence B. Katz ◽  
Hilary Cameron ◽  
Frederico Ceppa
Keyword(s):  
Glycemic Control ◽  
Treatment Satisfaction ◽  
Diabetes Management ◽  
Mobile App ◽  
Spanish Language ◽  
Control Group ◽  
Hispanic Population ◽  
Diabetes Treatment ◽  
Language Version ◽  
Control Subjects

To demonstrate the clinical value of OneTouch (OT) Verio Flex glucose meter used in combination with a Spanish-language version of the OT Reveal mobile application (app) to support diabetes care and improve glycemic control in an underserved Hispanic population with type 2 diabetes. Test subjects (<i>n </i>= 81) used the meter and app for 12 weeks, while a randomized control group (<i>n </i>= 39) used their own glucose meters without connection to an app. Thereafter, test subjects continued the same regimen for an additional 12 weeks to determine the durability of effect, and control subjects crossed over to use the new meter and app.<b> </b>Test subjects experienced a mean reduction in A1C of 1.0% after 12 weeks (<i>P </i><0.001), a statistically significant greater reduction than in control subjects (<i>P </i>= 0.045). The improvement in A1C in test subjects was sustained over the next 12 weeks. Crossed-over subjects also demonstrated significant improvements in A1C (<i>P </i><0.001). Mean blood glucose was reduced significantly without an increase in hypoglycemia and results in range increased over 12 weeks of meter and mobile app use. Results were independent of subjects’ numeracy skills. Subjects using the new meter and app reacted favorably to the tools and expressed improvements in their diabetes treatment satisfaction based on Diabetes Treatment Satisfaction Questionnaire–Change scores. Use of the OT meter and a Spanish-language version of its diabetes management app in an underserved population helped participants achieve a sustained improvement in glycemic control. The tools were well received by the subjects and may have important utility in other low-numeracy, low-literacy populations. <div><br></div>

scholarly journals Use of a Meter With Color-Range Indicators and a Mobile Diabetes Management App Improved Glycemic Control and Patient Satisfaction in an Underserved Hispanic Population: “Tu Salud”—a Randomized Controlled Partial Cross-Over Clinical Study

2021 ◽  
Author(s):  
Maria Aparicio ◽  
Laurence B. Katz ◽  
Hilary Cameron ◽  
Frederico Ceppa
Keyword(s):  
Glycemic Control ◽  
Treatment Satisfaction ◽  
Diabetes Management ◽  
Mobile App ◽  
Spanish Language ◽  
Control Group ◽  
Hispanic Population ◽  
Diabetes Treatment ◽  
Language Version ◽  
Control Subjects

To demonstrate the clinical value of OneTouch (OT) Verio Flex glucose meter used in combination with a Spanish-language version of the OT Reveal mobile application (app) to support diabetes care and improve glycemic control in an underserved Hispanic population with type 2 diabetes. Test subjects (<i>n </i>= 81) used the meter and app for 12 weeks, while a randomized control group (<i>n </i>= 39) used their own glucose meters without connection to an app. Thereafter, test subjects continued the same regimen for an additional 12 weeks to determine the durability of effect, and control subjects crossed over to use the new meter and app.<b> </b>Test subjects experienced a mean reduction in A1C of 1.0% after 12 weeks (<i>P </i><0.001), a statistically significant greater reduction than in control subjects (<i>P </i>= 0.045). The improvement in A1C in test subjects was sustained over the next 12 weeks. Crossed-over subjects also demonstrated significant improvements in A1C (<i>P </i><0.001). Mean blood glucose was reduced significantly without an increase in hypoglycemia and results in range increased over 12 weeks of meter and mobile app use. Results were independent of subjects’ numeracy skills. Subjects using the new meter and app reacted favorably to the tools and expressed improvements in their diabetes treatment satisfaction based on Diabetes Treatment Satisfaction Questionnaire–Change scores. Use of the OT meter and a Spanish-language version of its diabetes management app in an underserved population helped participants achieve a sustained improvement in glycemic control. The tools were well received by the subjects and may have important utility in other low-numeracy, low-literacy populations. <div><br></div>

scholarly journals IMPACT OF NUTRITION EDUCATION AND DIET THERAPY ON GLYCEMIC CONTROL IN PATIENTS WITH TYPE 2 DIABETES

2020 ◽  
pp. 1-2
Author(s):  
B. Premagowri
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Nutrition Education ◽  
Diabetes Management ◽  
Fasting Blood Glucose ◽  
Diet Therapy ◽  
Information Communication ◽  
Type 2 Diabetics ◽  
Post Test

Lifestyle modications including alteration of diet and physical activity are the rst lines of management during diabetes. The objective of the study was to evaluate the effects of nutrition education on glycemic control in type 2 diabetics. Around 410 newly detected type 2 diabetics were selected and socio-economic, anthropometric, dietary survey and biochemical data were collected by using the standard interview schedule. Programmed nutrition education using Information Communication Technology (ICT) were conducted to all the selected subjects. Using questionnaire, pre and post test was conducted to nd the knowledge improvement on diabetes management. The mean scores 9.90±1.60 obtained in pre-test were increased to 17.85 ±1.15 after nutrition education. For the selected subjects without hypoglycemic drugs, fasting blood glucose reduced by 27.92mg/dl (t= 8.612), post prandial blood glucose reduced by 53.94mg/dl (t= 14.442) and HbA1c reduced by 0.55% (t= 13.987). Thus, imparting nutrition education through ICT tools was found to be effective in improving the level of nutrition knowledge.

scholarly journals Identification of Type 2 Diabetes Management Mobile App Features and Engagement Strategies: Modified Delphi Approach (Preprint)

2019 ◽  
Author(s):  
Hanan A Alenazi ◽  
Amr Jamal ◽  
Mohammed A Batais
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Diabetes Management ◽  
Mobile App ◽  
Patient Specific ◽  
Moderate Degree ◽  
Modified Delphi ◽  
Engagement Strategies ◽  
Delphi Approach

BACKGROUND Diabetes is a significant public health issue. Saudi Arabia has the highest prevalence of type 2 diabetes mellitus (T2DM) in the Arab world. Currently, it affects 31.6% of the general population, and the prevalence of T2DM is predicted to rise to 45.36% by 2030. Mobile health (mHealth) offers improved and cost-effective care to people with T2DM. However, the efficiency of engagement strategies and features of this technology need to be reviewed and standardized according to stakeholder and expert perspectives. OBJECTIVE The main objective of this study was to identify the most agreed-upon features for T2DM self-management mobile apps; the secondary objective was to identify the most agreed-upon strategies that prompt users to use these apps. METHODS In this study, a 4-round modified Delphi method was applied by experts in the domain of diabetes care. RESULTS In total, 11 experts with a mean age of 47.09 years (SD 11.70) consented to participate in the study. Overall, 36 app features were generated. The group of experts displayed weak agreement in their ranking of intervention components (Kendall W=0.275; <i>P</i>&lt;.001). The top 5 features included insulin dose adjustment according to carbohydrate counting and blood glucose readings (5.36), alerting a caregiver of abnormal or critical readings (6.09), nutrition education (12.45), contacts for guidance if required (12.64), and offering patient-specific education tailored to the user’s goals, needs, and blood glucose readings (12.90). In total, 21 engagement strategies were generated. Overall, the experts showed a moderate degree of consensus in their strategy rankings (Kendall W=0.454; <i>P</i>&lt;.001). The top 5 engagement strategies included a user-friendly design (educational and age-appropriate design; 2.82), a free app (3.73), allowing the user to communicate or send information/data to a health care provider (HCP; 5.36), HCPs prescribing the mobile app in the clinic and asking about patients’ app use compliance during clinical visits (6.91), and flexibility and customization (7.91). CONCLUSIONS This is the first study in the region consisting of a local panel of experts from the diabetes field gathering together. We used an iterative process to combine the experts’ opinions into a group consensus. The results of this study could thus be useful for health app developers and HCPs and inform future decision making on the topic.

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